MONTANA COMPREHENSIVE
My fellow Montanans,
Most of us have been aff ected by cancer personally or through our family mem- bers. Cancer is not selective. As Montanans, we have an opportunity to work together to lessen the negative impact of cancer within our great state.
Eff ective cancer prevention and control requires thorough, collaborative plan- ning and coordination. Th e Montana Cancer Control Coalition (MTCCC) has taken on that task. Over the past 5 years, and going forward into the next 5, the MTCCC has brought together hundreds of people from around the state to reduce the burden of cancer in Montana. Together they have created a plan that will help prevent and control cancer. Th ese committed people have shared their collective knowledge and expertise for the good of all Montana families.
Th e result is the 2011–2016 Montana Comprehensive Cancer Control (CCC) Plan. Th e plan is a living docu- ment, a road map of activities that will change and evolve over time while decreasing the overall burden of cancer in Montana. Th e CCC Plan provides ways to become involved in implementing strategies for compre- hensive cancer control. It is a plan that honors our ability to make progress in our eff orts to prevent and control a deadly disease. Th is is a process that can and should give us hope for the future. By working together, we can truly ensure a healthier Montana.
Mission Purpose
Guiding Principles
To reduce cancer incidence, morbidity, and mortal- ity in Montana through a collaborative partnership of private and public individuals and organizations.
To develop, implement, promote, and advocate for a Th e Comprehensive Cancer Control (CCC) Plan will serve as a guide for cancer control programs in Montana. Th is guide will allow involvement of all touched by cancer and will encourage statewide, community-level participation. It has been designed to evolve with changing circumstances and to allow fl exible and creative responses to emerging issues.
Th e CCC Plan will promote collaboration to achieve comprehensive cancer control in Montana.
• Best practices
• Comprehensive
• Cost sensitive
• Culturally sensitive
• Data driven
• Evidence based
Vision
A comprehensive, statewide, evidence-based approach to reducing the burden of cancer in Montana, moti- vated by compassion…an investment in the future.
Anna Whiting Sorrell, Director
Department of Public Health and Human Services
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Table of Contents
Executive Summary... 2
Prevention ... 9
Screening & Early Detection... 15
Treatment & Research ... 21
Quality of Life & Survivorship ... 27
Get Involved ... 33
Evaluation ... 37
Glossary ... 40
References ... 42
Resources ... 43
Executive Summary
Cancer is the second-leading cause of death among Montana residents, aft er diseases of the circulatory system such as heart disease and stroke. Each year, an average of 4,690 Montana residents are diagnosed with some form of cancer, and an average of 1,890 die from cancer. It is estimated that 42,000 Montana residents are cancer survivors. Montana’s cancer burden is lower than that of the United States as a whole for all cancer sites combined and for many individual sites. However, more can be done to further reduce the cancer burden in Montana.
Four kinds of cancer-prostate, lung, breast, and colorectal-account for 58% of all incident cancers and 50% of all cancer deaths. None of the other kinds of cancer accounts for more than 5% of cases, and the great majority accounts for 1% or less.
Th e single-greatest cancer prevention measure that can be implemented is tobacco prevention or cessation.
• More than 90% of cases of cancer in the lung and bronchus are attributed to cigarette smoking and exposure to secondhand smoke. Th ese cancers, accounting for 15% of all newly diagnosed cases in Montana, are almost entirely preventable.
• One third of all cancer deaths in Montana are caused by cigarettes.
• Cigarette smoking also increases the risk of cancers of the sinuses, mouth, throat, liver, pancreas, stomach, kidneys, bladder, colon and rectum, and cervix.
Screening for breast, cervical, and colorectal cancer is eff ective and saves lives, either by fi nding cancer at an early stage when it is most treatable or by fi nding and treating precancerous lesions so they do not progress to cancer.
• Colorectal cancer accounts for 10% of all cases and can be detected by either fecal occult blood testing
The Burden of Cancer in Montana
fi nd and remove polyps and other precancerous growths.
• Invasive cervical cancer has been almost eliminated by the widespread use of Papanicolaou (Pap) screening.
• Mammography is a minimally invasive procedure that can discover a large proportion of breast tumors at an early stage when they are most treatable. More than 95% of women whose breast
Blackfeet Reservation
Home of the Blackfeet Nation headquartered in Browning, Montana
Crow Reservation
Home of the Crow Nation headquartered in Crow Agency, Montana
Flathead Reservation
Home of the Confederated Salish, Pend d’Oreille, and Kootenai Tribes headquartered in Pablo, Montana
Fort Belknap Reservation
Home of the Gros Ventre and Assiniboine Tribes headquartered in Fort Belknap Agency, Montana Fort Peck Reservation
Home of the Assiniboine and Sioux Tribes headquartered in Poplar, Montana
Little Shell Tribe of Chippewa Indians of Montana State recognized
Northern Cheyenne Reservation
Home of the Northern Cheyenne Tribe headquartered in Lame
Cancer among American Indian Residents
Th e most common cancers among American Indian residents of Montana are the same as those for the state as a whole: prostate, breast, lung and bronchus, and colon and rectum. Approximately 250 cases of cancer per year are reported and diagnosed in American Indians in Montana. Th e incidence rates of prostate and breast cancers among American Indian residents are not signifi cantly diff erent statistically from the statewide incident rates. However, American Indians have signifi cantly higher incidence rates statistically of lung, colorectal, kidney, stomach, and liver cancers.
Cancer survival among American Indian residents of Montana is slightly lower than survival for all Montana residents for patients diagnosed between 1998 and 2002 (to allow for at least 5 years of survival). Th e lower survival rate is attributable in part to later stage at diagnosis among American Indian patients, which did not improve between 1998 and 2002 and between 2003 and 2007.
Cancer Disparities
Blackfeet
Flathead Rocky Boy’s Fort Belknap
Fort Peck
Northern Cheyenne Crow
Urban Indian Centers Tribal Reservations
*American Indian lung cancer rate is stati sti cally signifi cantly higher than White lung cancer rate.
Approximately 85% of cases of lung cancer are attributable to smoking cigarettes; 54% of American Indian adults in Montana smoke, compared to 14%
of non-American Indian adults in Montana. Among American Indian adults in Montana age 50 and older, 43% have never had an endoscopy, compared to 57%
of non-American Indian adults age 50 and older in Montana.
In Montana, people with disabilities, including physical, sensory, developmental, and intellectual, experience health disparities. Specifi cally, 68% of women with disabilities received a mammogram in a two-year period compared to 73% of women without disabilities (BRFSS, 2008). For people with disabilities, a lack of accessible medical equipment, such as height- adjustable exam tables and mammography machines, as well as wheelchair-accommodating weight machines also creates problems for receiving preventive services (Mudrick & Schwartz, 2010; Drew & Short, 2010).
It is the intention of the MTCCC, along with its supporting partners, to address the barriers to healthcare for all Montanans and to work to break down these barriers.
Tribes in Montana each have their own unique cultures, traditions,
and histories. For many American Indians, symbols and their meanings are an integral part of their culture.
In collaboration, the MTCCC and the Montana American Indian Women’s Health Coalition (MAIWHC) created a symbol featured in the CCC Plan, designed to represent all tribes in Montana.
Th is symbol is used throughout the plan to showcase American Indian activities around the state. Th e American Indian symbol was created as a circle to represent cultural beliefs, a lodge (teepee) to represent families, and a buff alo to represent endurance and strength.
Montana Comprehensive Cancer Control Plan Partners
Cancer Survivors
& Caregivers
DPHHS
CoC-Accredited Centers
Local Health Departments National Cancer
Institute Other
Organizations
American Cancer Society
Montana Comprehensive Cancer Control Plan
2011-2016
Who
What
How
Th e Montana Cancer Control Coalition (MTCCC) is a statewide collaborative eff ort of a diverse group of individuals and organizations working together to reduce cancer incidence, morbidity, and mortality for all Montanans. Th e MTCCC was formed in 2003 when concerned stakeholders around the state came together to address issues across the cancer continuum, from prevention and early detection to survivorship. Using a coordinated and integrated approach to controlling cancer, the MTCCC strives to ensure better quality of life and to enhance the odds of survivorship through prevention, early detection, and state-of-the-art cancer care.
Th e Comprehensive Cancer Control (CCC) Plan is a guide for achieving the following overarching goals:
1. Prevent the incidence of cancer by reducing risk factors.
2. Detect cancer at the earliest stage possible.
3. Promote access to quality comprehensive
cancer care.
4. Optimize the quality of life and survivorship rates for those aff ected by cancer.
5. Support research to best improve cancer control.
6. Monitor, document, and work to eliminate disparities across the cancer continuum.
7. Develop and support policies and initiatives that enable cancer control.
8. Utilize an evidence-based approach with best practices for cancer control.
Th e CCC Plan is a living document that represents Montana’s determination to prevent and control cancer by working together. Th e CCC Plan describes
If you are a Montana resident:
• Avoid tobacco use.
• Get recommended cancer screenings, and encourage family members and friends to get cancer screenings.
• Participate and volunteer in cancer control activities in your community.
• Complete an advanced directive.
• Become a member of the MTCCC.
If you are a cancer survivor:
• Share your experience to educate the public about the needs of survivors.
• Be a mentor to survivors and co-survivors to empower them to be active participants in their healthcare decisions. Join a support group.
• Encourage employers and schools to support cancer survivors and their needs as they transition through their cancer diagnoses.
• Join an advocacy group or organization working to improve survivor experiences and quality of life.
If you are an educator:
• Promote healthy lifestyle behaviors to students, families, and staff .
• Provide information on the return-to-school transition process for childhood survivors, families, and school staff .
• Encourage staff to get recommended cancer screenings.
• Provide healthy food options to students and staff .
• Organize student advocacy groups to support cancer control activities.
• Learn how to work with kids and families when mentors, advocates, and more. Th e CCC Plan enables all individuals and organizations to get involved in comprehensive cancer control by implementing strategies and working together to reduce the burden of cancer. Following are ways to get involved in cancer control and activities that support the CCC Plan.
If you are a healthcare provider:
• Ask all patients whether they use tobacco products, and provide tobacco cessation interventions to patients who do.
• Screen patients for obesity, and support those working to achieve or maintain a healthy weight.
• Recommend cancer screenings to every eligible patient at every opportunity.
• Provide cancer patients with a comprehensive survivorship care plan.
• Pursue continued education to understand survivor needs and available best practices.
• Talk with patients about the benefi ts of palliative care and hospice.
• Work with the MTCCC to include cancer control messages on display boards and advertising spaces.
If you are an employer:
• Provide access to tobacco-use cessation programs for employees.
• Implement a worksite wellness program.
2006 2006 2008 2009 2010
2006 2007 2009 2009
Montana Comprehensive Cancer Control Plan introduced.
Centers for Disease Control and Prevention funds awarded to Montana DPHHS to support CCC Plan implementation.
Montana Pain Initiative directed the Pain Practice Improvement Program for 13 rural hospitals, long-term-care facilities, and home health agencies.
The Clean Indoor Air Act implemented; all indoor workplaces, bars, and casinos become smoke- free.
Provider Advisory Group created within the MTCCC structure.
First Bette Bohlinger
Leadership Award presented.
Clinical Trials Symposium at MTCCC Fall Meeting.
Cancer Screening Coverage Disclosure Bill signed into law.
Childhood Cancer Symposium held at MTCCC Fall Meeting.
Th is timeline is an overview of progress made on the 2006–2011 Montana CCC Plan. Although we cannot report all successes achieved statewide, this highlights some of the progress made over the past 5 years.
• Encourage employees to be physically active and to select nutritious foods.
• Provide sun-protective gear or products for those working outside.
• Provide full coverage for recommended cancer screenings and time off for employees to get screened.
• Provide information on return-to-work transition issues to survivors and their co-workers, and implement systems to allow employees to continue their work during treatment.
If you are a policy maker:
• Support policies to improve funding for cancer survivorship services, screening, treatment, research, and surveillance.
• Support policies that support and encourage healthy lifestyle choices.
For additional information on how to get involved, please visit the MTCCC website at
www.mtcancercoalition.org
Bette Bohlinger Leadership Award
Bette Bohlinger, Lieutenant Governor John Bohlinger’s late spouse, lost her brave battle with cancer in January 2006 aft er being diagnosed with acute myeloid leukemia in 2004. Bette was an inspiration to many Montanans, exhibiting leadership and encouragement to families aff ected by cancer.
She was a role model for people with cancer, encouraging them to share their experiences and give hope to others through their stories. Bette was a tireless advocate to get Montanans signed up for the National Marrow Donor Program. Although Bette herself was in need of a donor, she also hoped that her illness could help bring hope to others suff ering a similar disease. Bette was also an early supporter and participant with the Montana Cancer Control Coalition.
In honor of Bette, the MTCCC created the Bette Bohlinger Leadership Award in 2006 to honor exceptional individuals or organizations that encourage, inspire, and lead others. Th ese award winners have positively contributed to cancer control activities in Montana and have been actively engaged in moving along the mission and goals of the MTCCC.
Bette Bohlinger Leadership Award: A Commitment to Excellence
Th e quotes in this section were provided by the people or organizations who recommended the recipients for the award.
2006: Dr. Barbara Lloyd, Helena: “Barb has provided not only me the tools to succeed but others as well. She has trained me in my roles within the MTCCC and has been an inspirational leader. Barb has shown her outstanding commitment to the MTCCC.”
2007: Rita McDonald, Lame Deer:“Rita brings a unique perspective to the MTCCC as a survivor and advocate.
She embodies why and how we do the work we do. Rita is making a diff erence in Montana and is contributing to state and local cancer control activities.”
2008: Sue Warren, Great Falls: “Sue’s contributions to the MTCCC have been tremendous. She has unbelievable energy and passion for cancer awareness, prevention, and control, and she carries these qualities with her in her personal and professional lives.”
2009: Betsy Smith, Great Falls:“Betsy has been an integral part of the MTCCC leadership and an active member of the MTCCC. She has risen to the challenges presented to her and encompasses all the qualities of stewardship, professionalism, and leadership that the Bette Bohlinger Award refl ects.”
2010: Dr. Thomas Purcell, Billings: “Dr. Purcell has contributed in so many ways to the success of the MTCCC.
From the fi rst planning meeting when MTCCC was becoming a reality to now, Dr. Purcell has been there to lend his expertise, his vision, and his time to the cause of lowering the incidence of cancer in Montana.”
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P rev ention
My mission to educate others about primary and second- ary skin cancer prevention and early detection began over 20 years ago with my young husband’s death from melanoma. Working in our community and the larger community of dermatology nurses has inspired me.
My children are also in- volved. One is an ER doc- tor; another has created a game-Smack a Mole©-that teaches young and old how to recognize skin cancer and describes methods to prevent UV exposure; and the third shares by example as well as
word what he does to prevent UV exposure.
Th e Montana Cancer Control Coalition works with both the Montana medical community and the com- munity at large to support all levels of cancer care from prevention to advocacy to support for our surviv- ing families. I am proud and passionate about the work we are doing to advocate prevention and education for all Montanans! Working with the Prevention Implementation Team allows me to share the SunAWARE message to our communities and hopefully will result in prevention and earlier diagnosis of skin cancer!
-Karrie Fairbrother, BSN, RN, DNC, CDE
Prevention
Karrie and Gary Fairbrother
Montanans who engage in certain unhealthy behaviors are at increased risk for cancer. Although not all cancers are preventable, many cancers are linked to specifi c behavioral choices, such as tobacco use, alcohol consumption, physical inactivity, poor diet, and unprotected exposure to ultraviolet (UV) rays.
In Montana, 1,400 people die each year from tobacco use. Two key risk factors for developing lung cancer are tobacco use and exposure to secondhand smoke. Both are preventable risk factors. Tobacco use does not lead only to lung cancer; a wide variety of cancers can be attributed to smoking. Approximately 3,000 distinct chemicals occur naturally in tobacco leaves, and 1,000 more are introduced into tobacco products though agricultural practices and postharvest processing. Fift y-fi ve chemicals in cigarette smoke are established human carcinogens, and cigarettes are the major source of exposure to these chemicals for most people (TSR, July 2008).
Regular alcohol consumption, even as little as a drink or two a day, increases the risk of cancer at several sites throughout the body. Alcohol itself is a carcinogen, as are the chemicals the body produces when it breaks down alcohol. In addition, alcohol interferes with the detoxifi cation of other potential carcinogens (QSR, July 2009).
Being obese or overweight has been linked to cancers of the colon, rectum, esophagus, kidney, endometrium, breast, and thyroid, in addition to being risk factors for other chronic health conditions. Poor nutrition and lack of adequate exercise can lead to obesity, increasing the risk of cancer. An estimated 20 to 30% of the most common cancers may be related to excess weight and physical inactivity.
Most skin cancers are squamous cell and basal cell cancers of the epidermis, which are commonly superfi cial and have an excellent prognosis when diagnosed and treated promptly. Malignant melanoma is less common but much more serious and has a poorer prognosis. UV radiation is part of the spectrum of energy from the sun and also is emitted by artifi cial sources, including sun lamps and tanning beds.
Exposure and protection from UV rays is a preventable risk factor in developing skin cancer.
Over the next 5 years, the Prevention Implementation Team will work with prevention partners to reduce the burden of cancer in Montana by focusing on reducing the prevalence of tobacco usage and secondhand smoke exposure in Montana residents, reducing obesity levels in children and adults, limiting artifi cial tanning facility usage, and encouraging sun safety education.
P rev ention
Objective 1.2: By 2016, reduce exposure to secondhand smoke by working with the MTUPP and other tobacco control and prevention programs.
Baseline: Youth: 60% of youth have had exposure to secondhand smoke.
Adults: 14% of adults are regularly exposed to secondhand smoke at home.
Data Source: PNA, 2004; ATS, 2004 Target: Youth: 40%
Adults: 9%
Strategy 1: Advocate for the continued protection of the Montana Clean Indoor Air Act.
Strategy 2: Support strategic eff orts to establish more smoke-free or tobacco-free policies on
American Indian reservations, in park and recreational areas, on hospital campuses, and in multiunit housing facilities.
Strategy 3: Support eff orts to establish setback policies and/or laws for smoking around public buildings.
Objective 1.1: By 2016, decrease the prevalence of tobacco use among adults and youth by working with the Montana Tobacco Use Prevention Program (MTUPP) and other tobacco partners.
Goal 1: Support the work of prevention partners to reduce the impact of unhealthy lifestyles on cancer risk.
Baseline: Adults: Smoking (18%); smokeless (12%) Youth: Smoking (19%); smokeless (9%) Data Source: ATS, 2004; PNA, 2004 Target: Adults: Smoking (14%); smokeless (10%)
Youth: Smoking (14%); smokeless (7%)
Strategy 1: Promote the Montana Tobacco Quit Line and other existing evidence-based resources to increase cessation attempts.
Strategy 2: Support the MTUPP’s React Against Corporate Tobacco (reACT) program to prevent the initiation of tobacco use among youth.
Strategy 3: Support MTUPP’s eff orts to eliminate disparities in low-income and American Indian populations related to tobacco use and its eff ects.
Strategy 4: Educate stakeholders and partners on the eff ectiveness of increasing the unit price of tobacco products to promote cessation.
Th e Fort Belknap Indian Reservation promotes physical activity and healthy habits by holding events throughout the year. Some of the events include support groups, fun run/walks, nutrition and cooking classes, aft er-school and holiday break activities for youth, round dances, pow- wows, Native games, Native regalia making classes, stress relief classes, physical fi tness classes, and an annual half marathon in May as well as the Ultimate Health Challenge in coordination
with the Milk River Pow-Wow and a fi rst-ever triathlon planned for September 2011. Th ese are some of the events that help keep Fort Belknap residents active and on their way to healthier lifestyles!
Objective 1.3: By 2016, reverse the trend of increasing self-reported overweight and obesity in Montana by working with the Montana Nutrition and Physical Activity Program (NAPA) and other obesity prevention partners.
Baseline: Adults: 37% are overweight; 19% are obese.
Youth: 8% are overweight/obese; 12% are at risk for becoming overweight.
Data Source: YRBSS, 2003, 2009;
BRFSS, 2004, 2009
Interim: Adults: 38% are overweight; 24% are obese.
Youth: 12% are overweight; 10% are obese.
Target: Adults: 37% overweight; 19% obese.
Youth: 12% overweight; 8% obese.
Overweight: respondents with BMI ≥ 25 and < 30.
Obese: respondents with BMI ≥ 30.
Strategy 1: Partner with worksites and support worksite wellness campaigns to encourage biking and walking to work, nutritional support strategies, and worksite lactation programs.
Strategy 2: Work with the Offi ce of Public Instruction and individual school districts to strengthen school wellness policies to:
• include access to nutritious food for all students
• encourage “active transportation” to school with programs such as Safe Routes to School
• provide quality and age-appropriate physical education to all students
• open up recreation facilities to the community aft er hours
• reduce screen time usage.
Strategy 3: Utilize community media campaigns to encourage nutrition and physical activity among Montana residents.
0 5 10 15 20 25 30 35 40 45
2001 2002 2003 2004 2005 2006 2007 2008 2009
Percent
Overweight Obese
Montana Adults
Objective 2.1: By 2016, reduce the proportion of adolescents who use artifi cial sources of ultraviolet light for tanning.
Baseline: 16% of adolescents in grades 9–12 Data Source: YRBSS, 2009; CDC, 2010 Target: 15%
Strategy 1: Partner with dermatology groups in Montana to support public policy restricting artifi cial tanning facility usage by minors.
Strategy 2: Utilize community media campaigns to discourage youth from using artifi cial tanning facilities.
Objective 2.2: By 2016, increase by 5 the number of new aft er-school programs, educational settings, recreational settings, or organizations to implement sun safety education (Sun Wise or SunAWARE).
Baseline: 0 programs
Data Source: MCCP data Target: 5 new programs
Strategy 1: Host workshops on skin cancer prevention in schools and with sports teams in partnership with the MEA-MFT, the Montana Association of School Nurses, and the
Montana Coaches Association.
Strategy 2: Work with school paraprofessionals to host workshops on skin cancer prevention in schools and aft er-school programs.
Strategy 3: Work with organizations such as 4-H, Boy Scouts, Girl Scouts, and Boys and Girls
Clubs to include sun safety education within their programs and/or to develop policies or recommendations surrounding sun safety at their events.
P rev ention
Goal 2: Promote cancer risk–reducing behaviors through evidence-
based education and advocacy.
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Screening &
Early Detection
Priscilla Robinson is a 75-year-old woman who was born and raised on the Northern Cheyenne Indian Reservation and is an enrolled member of that tribe.
In 2008, Priscilla went to the Indian Health Service in Lame Deer for her an- nual checkup. She had never had a colonoscopy or any other screening for colorectal cancer. Although she had no symptoms relat- ed to colorectal cancer, the doctor suggested she take a fecal occult blood test kit home with her as a screen- ing tool. Aft er the kit was evaluated, she was referred for further testing. Priscilla was then diagnosed with colon cancer.
Priscilla is doing well and since her diagnosis has been an advocate for her family to get their colorectal cancer screenings. Priscilla is the perfect example of how one can use a very inexpensive screening tool to
n n o c s e d a
S cr eening & Early Det ec tion
Priscilla Robinson
Early detection of breast, cervical, and colorectal cancers saves lives by fi nding cancers when
they are still localized and when treatment is more likely to succeed. Breast, cervical, and colorectal cancer patients have higher rates of survival if the cancers are found at the early stages. In Montana, promoting early detection methods and access to healthcare and screening opportunities for all citizens is a priority for the MTCCC.
Breast cancer is the most common cancer among Montana women. On average, 800 Montana women are diagnosed with breast cancer each year (QSR, 2006). Mammography is the best available method to detect breast cancer in its earliest, most treatable stage. If detected early, the U.S. 5-year survival rate for localized breast cancer is 97%.
Cervical cancer screening using the Papanicolaou (Pap) test detects cancer as well as precancerous lesions.
Pap tests can fi nd cervical cancer at an early stage, when it is most curable, and can actually prevent the disease if precancerous lesions found during the test are treated.
Colorectal cancer is the fourth most common incident cancer in Montana and the fourth most common cause of cancer death (MCTR, 2010). Nearly 80% of colorectal cancer cases could be prevented by screening methods that fi nd and remove polyps and precancerous lesions (QSR, April 2009). Several screening strategies are used to detect colorectal cancer, with the two main approaches being noninvasive stool tests and direct examination tests.
All adults should discuss cancer prevention, screening, and early detection with their primary care providers. For breast, cervical, and colorectal cancer, tests that improve outcomes are available to screen the general population. Avoiding tobacco use is the best way to decrease risk of lung cancer. A discussion with your provider will help you decide what is best for you. For example, the American Cancer Society recommends that men over the age of 50 talk with their providers about the pros and cons of prostate cancer screening to determine what is right for them. For all other cancers, research continues to search for the best approach to decrease mortality.
Over the next 5 years, the Screening and Early Detection Team will be working to reduce the burden of cancer in Montana by increasing breast, cervical, and colorectal cancer screenings and broadening the use of screening opportunities by all Montanans.
S cr eening & Early Det ec tion
Objective 1.1: By 2016, increase compliance with nationally recognized guidelines for cancer screenings.
Goal 1: Promote compliance with cancer screening guidelines.
Baseline: Breast: 72% of women over age 40 have had a mammogram within the past 2 years.
Cervical: 86% of women over age 18 have had a Pap test within the past 3 years.
Colorectal: 53% of adults over age 50 have ever received a sigmoidoscopy or colonoscopy exam.
Data Source: BRFSS, 2004, 2008
Target: Breast: 75% of women over age 40 will report having had a mammogram within the past 2 years.
Cervical: 88% of women over age 18 will report having had a Pap test within the past 3 years.
Colorectal: 60% of adults over age 50 will have had a sigmoidoscopy or colonoscopy exam.
Strategy 1: Promote nationally recognized guidelines to the healthcare provider community and to
the public.
Strategy 2: Work with insurance benefi t providers and wellness educators to educate clients on covered services for screening utilizing small media campaigns.
Objective 1.2: By 2016, reduce the number of people over age 50 who report they are unaware they need a breast or colorectal cancer screening service.
Baseline: Breast: 35%
Colorectal: 43%
Data Source: BRFSS, 2007 Target: Breast: 30%
Colorectal: 38%
Strategy 1: Implement small media tools such as videos and printed materials (postcards, letters, brochures, fl yers, and newsletters) to inform and motivate people to get screened.
Strategy 2: Implement group and one-on-one education to increase awareness and availability of breast and colorectal cancer screening services and how to access these services.
Strategy 3: Work with specifi c groups, including but not limited to American Indians and people with disabilities, to educate through culturally competent means on the need for screening.
Objective 1.3: By 2016, reduce the number of people who report their physician did not recommend a breast or colorectal cancer screening.
Baseline: Colorectal: 36%
Breast: 11%
Data Source: BRFSS, 2007 Target: Colorectal: 30%
Breast: 5%
Strategy 1: Engage physician champions to educate physicians on cancer screening rates, nationally recognized screening guidelines, and quality improvement tools, such as the “How to Increase Preventive Screening Rates in Practice Toolbox.”
Strategy 2: Ensure healthcare staff receive ongoing education on screening rates, nationally recognized screening guidelines, and quality improvement tools, such as the “How to Increase Preventive Screening Rates in Practice Toolbox.”
Objective 2.1: Annually, maximize the number of uninsured and underinsured Montanans screened for breast, cervical, and colorectal cancers through the Montana Cancer Screening Program (MCSP).
Goal 2: Broaden the use of low- and no-cost cancer screening services in Montana.
Baseline: 100% utilization
Data Source: MCSP, 2006 Target: 100% utilization
Strategy 1: Educate healthcare providers and their staff about low- and no-cost cancer screening resources.
Strategy 2: Implement group and one-on-one education in the target population about low- and no-cost resources available to maximize the number of people covered.
Strategy 3: Implement small media tools such as videos and printed materials (postcards, letters, brochures, fl yers, and newsletters) to inform people about low- and no-cost resources.
Objective 2.2: Annually, maximize the utilization of grants awarded for uninsured and underinsured Montanans screened for breast cancer through the Montana affi liate of the Komen Foundation.
Baseline: 100% utilization
Data Source: Komen Foundation, 2010 Target: 100% utilization
Strategy 1: Ensure that healthcare providers and organizations receive ongoing education in regard to grants and resources available through the Montana Komen Foundation.
Strategy 2: Annually, in October, encourage eligible MTCCC members and others to apply for funding and resources through the Montana Komen Foundation.
S cr eening & Early Det ec tion
“Pink Ribbon Bingo” and “Boo Bee Bingo” were held in 2010 on the Crow Agency and in Lame Deer to educate women on the importance of breast and cervical cancer
screening. In total, over 500 women attended both events, with more than 200 women qualifying for the Montana Breast and Cervical Health screening program. Donations and gift s were collected and presented to women in attendance. Sponsors included but were not limited to Northern
Cheyenne Tribal Health, St. Vincent’s Healthcare, Ashland Community Health Center, Billings Clinic, Center for Native Health Partnerships, and RiverStone Health. Attendees enjoyed dinner together, heard from cancer survivors, and played bingo. Both events were great successes and have become
annual events.
“ B C e o s e t p p i C A
l f l h h d
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Treatment
& Research
In March 1990, I became ill while on a trip to Th ailand.
I was examined and tested and given instructions to go to the emergency room when I arrived at home.
In Great Falls, I learned of my leukemia diagnosis. My treatment began the next day. I was in the hospital for 76 days, with one weekend at home in Glasgow. Th e leukemia was cured. I have enjoyed my life and my fam- ily since those days of illness.
In 1993, with a new cancer diagnosis, I was back for ra- diation treatments and de- cided to participate in clini- cal trials for prostate cancer.
With my doctor’s care and research, I have continued to respond to the treatments he advises. I know that I owe my life to Dr. Harrer and the treatment he and his wonderful, caring staff have given me.
Today, I am once again under care for prostate cancer; I have received hormonal therapy, radiation therapy,
Milton (Swede) Olsen, 20-year cancer survivor
T rea tment & Resear ch
Milt (S d ) Ol 20 i
A variety of treatment methods for cancer are available depending on the type and stage of cancer as well as various individual factors that include age, health, and cultural and personal preferences. Th e treatment of cancer for Montanans oft en depends on state-of-the-art care being available, accessible, aff ordable, and utilized. Although good cancer treatment can be available at the local level, Commission on Cancer (CoC)- accredited cancer programs ensure the quality of cancer care through adherence to national standards, multidisciplinary consultation, and quality assessments. As of January 2011, six of Montana’s medical facilities were CoC accredited.
Clinical trials are research studies with human participants to evaluate new ways to prevent, diagnose, or treat diseases, including cancer. Some new treatments are safer and more eff ective and will eventually become the new standard of care, but this can happen only with the proof provided by clinical trials. Only 3% of U.S. adults participate in clinical trials, although many more are potentially eligible. Clinical trials may be sponsored by drug companies, foundations, or individual medical centers. Most large cancer clinical trials are sponsored by federal agencies such as the National Cancer Institute (NCI) (QSR, July 2009). Many cancer treatment centers in Montana off er clinical trials to their patients. Th e Montana Cancer Consortium is an independent, not-for-profi t institution that receives support from the Community Clinical Oncology Program of the NCI to off er clinical trials through participating institutions and providers across Montana and northern Wyoming.
Over the next 5 years, the Treatment and Research Team will focus their eff orts to reduce the burden of cancer on Montanans by increasing the utilization rates of cancer patients participating in clinical trials and by supporting and increasing the number of CoC-accredited hospitals around the state to ensure the highest level of cancer treatment for all Montanans.
Objective 1.1: By 2016, increase the percentage of patients of Commission on Cancer (CoC)-accredited cancer programs that are annually accrued to clinical trials.
Goal 1: Ensure high-quality cancer research in Montana.
Baseline: 2%
Data Source: Montana Cancer Consortium, 2010; Montana Central Tumor Registry Target: 4%
Strategy 1: Work with the Montana Cancer Consortium (MCC) to promote available NCI clinical trials at the CoC-accredited cancer programs.
Strategy 2: Create a toolbox of clinical trials information and promote its use to providers eligible to accrue to the included clinical trials.
Strategy 3: Report quarterly NCI trials provider accrual data to the Cancer Committee or Tumor Board of
T rea tment & Resear ch
Objective 2.1: By 2016, increase and maintain the number of CoC-accredited sites.
Baseline: 6
Data Source: American College of Surgeons (ACoS), 2010 Target: 8
Strategy 1: Work with the CoC Cancer Liaison Physicians (CLPs) to maintain and encourage CoC
Goal 2: Ensure prevailing standards of care for all cancer patients in Montana.
1. Benefi s Hospitals (Community Hospital Comprehensive Cancer Program)
2. St. Patrick Hospital & Health Sciences (Community Hospital Comprehensive Cancer Program) 3. St. Peter’s Hospital (Community Hospital Cancer Program)
4. Billings Clinic (Community Hospital Comprehensive Cancer Program)
5. St. Vincent Healthcare (Community Hospital Comprehensive Cancer Program) 6. Bozeman Deaconess Cancer Center (Community Hospital Cancer Program)
Commission on Cancer-Accredited Centers
Great Falls 1 Helena
3 Missoula
2
Billings 4 5 Bozeman
6
Over the past 4 years, the Montana Cancer Institute Foundation has worked in partnership with the Confederated Salish and Kootenai Tribes (CSKT) Tribal Health and the University of Montana to study how genetic factors may infl uence response to cancer treatments in Native Americans.
Relationship building and cross-communication with the researchers and CSKT have been an essential part of this project. A Tribal Community Advisory Council has been formed to provide
regular input. One primary goal of this project is to develop and evaluate collaborative approaches for improving the diversity of populations participating in this type of research and who might benefi t from pharmacogenomic Objective 2.2: By 2016, increase the percentage of adherence to standard-of-care therapies for breast and colorectal cancers by the Montana CoC-accredited cancer programs.
Baseline: 1. Radiation is delivered to candidates under age 70 within 1 year following breast- conserving therapy. Montana: 92.6% (National: 81.6%)
2. Combination chemotherapy is considered or administered within 4 months of diagnosis for women under age 70 with AJCC T1cN0M0, or Stage II or III hormone receptor negative breast cancer. Montana: 91.1% (National: 81.6%)
3. Tamoxifen or third-generation aromatase inhibitor is considered or administered within 1 year of diagnosis for women with AJCC T1cN0M0, or stage II or III hormone receptor positive cancer. Montana: 79.8% (National: 71.3%)
4. Adjuvant chemotherapy is considered or administered within 4 months of diagnosis for patients under age 60 with AJCC Stage III (lymph node positive) colon cancer.
Montana: 74% (National: 84.9%)
5. At least 12 lymph nodes are removed and pathologically examined for resected colon cancer.
Montana: 78.5% (National: 79.8%)
6. Radiation therapy is considered or administered within 6 months of diagnosis for patients under age 80 with clinical or pathological AJCC T4N0M0 or Stage III receiving surgical resection for rectal cancer. Montana: 100% (National: 87.2%)
Data Source: Commission on Cancer’s National Cancer Data Base (NCDB), 2008
Target: 1. 95%
2. 92%
3. 95%
4. 90%
5. 90%
6. 90%
Strategy 1: Th e Cancer Liaison Physician (CLP) will evaluate and interpret the program’s performance using the NCDB data.
Strategy 2: Th e CLP (or the CLP’s designee) will report this information to the program’s Cancer Committee quarterly.
Strategy 3: Identify and disseminate best practices for adherence to these standard-of-care therapies.
